Recurrent UTI – Adult Female
1 Information Resources for Patients and Carers
Patient Information Leaflet:
Recurrent urinary tract infections
2 Development & Updates to this Pathway
Developed November 2014
3 Background Information / Scope of Pathway
This pathway has been developed jointly by the Leeds CCG planned care leads, Continence Urology and Colorectal Service (CUCS)
and consultants from Urology, Urogynaecology and Elderly Medicine within LTHT.
Urinary Tract Infection (UTI) is one of the most common reasons for presentation to primary care affecting 50 to 60% of women in their lifetime . Relapsing and recurrent infection is common with one study demonstrating 44% of patients have a further infection within a year . One third of these patients suffered relapsing infection caused by the same organism. Women over 55 years of age were more at risk with 53% suffering recurrence versus only 36% of younger women.
Recurrent UTI can be a debilitating disease for the patient but can also be a warning sign for abnormalities of the renal tract. This guideline assist the user in identifying those patients that require specialist investigation and consultation in managing their condition.
Presence of bacteria in the urine revealed by quantitative culture or microscopy.
Bacteriuria in a patient without any symptoms or signs of upper or lower UTI and confirmed by a second sample of urine.
Urinary Tract Infection (UTI); Symptomatic Bacteriuria
Symptoms of infection of the lower (dysuria, frequency, suprapubic pain) or upper (loin pain, fever, back ache) urinary tract associated with a significant bacteriuria.
A UTI involving the bladder only. Also referred to as cystitis.
A UTI involving the renal tract proximal to the bladder (i.e. kidneys). Also referred to as pyelonephritis.
Uncomplicated (Simple) UTI
An uncomplicated UTI is one that occurs in a healthy non-pregnant adult female in the absence of structural or functional abnormalities of the urinary tract .
A UTI caused by the same organism and occurring not more than 2 weeks after treatment of the original UTI .
Recurrent uncomplicated UTI
3 or more uncomplicated UTI's in 12 months.
A UTI in a child, adult male, pregnant woman, catheterized individual or a patient with underlying pathology of the renal tract (for example, neuropathic bladder, structural abnormality of the renal tract, immunosuppressed, renal transplantation etc).
A UTI may be considered post-coital if the interval between sexual intercourse and the onset of symptoms is consistently between 24 and 48 hours. 
 Epp, A., et al., Recurrent urinary tract infection. J Obstet Gynaecol Can. 32(11): p. 1082-101.
 Ikaheimo, R., et al., Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women.
Clin Infect Dis, 1996. 22(1): p. 91-9.
 Dason, S., J.T. Dason, and A. Kapoor, Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 5(5): p. 316-22.
 Hooton, T.M., Recurrent urinary tract infection in women. Int J Antimicrob Agents, 2001. 17(4): p. 259-68.
 Engel, J.D. and A.J. Schaeffer, Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women. Urol Clin
North Am, 1998. 25(4): p. 685-701, x.
4 Presents with Recurrent UTI Symptoms
Asymptomatic bacteriuria is not thought to be harmful and its treatment in the immuno-competent adult population does not reduce morbidity or mortality. Conversely its treatment is associated with adverse effects (increased spectrum of resistance, adverse drug reactions to antimicrobials) and is thought to have a protective role against invasion of uropathogenic strains of bacteria. A such it should not be treated [1,2].
 Nicolle, L.E., W.J. Mayhew, and L. Bryan, Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med, 1987. 83(1): p. 27-33.
 Nicolle, L.E., Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice. CMAJ, 2000. 163(3): p. 285-6.
5 Assess Red Flags Perform Urinalysis
Pathway excludes the following:
- Neurological disease - refer to Continence, Urology and Colorectal Service (CUCS)
- Catheterised (long term) - see Leeds Urinary Catheter Complications Pathway
- Pyelonephritis/upper UTI - see Leeds Acute Upper Urinary Tract Infection (Pyelonephritis) pathway
- Kidney transplant
- Haematuria - see Leeds Haematuria pathways
8 Three UTI's in 6 Months and four UTI's in 1 Year
Please see Leeds Health Pathways guidance for suggested management options
Please note this page is local suggested good practice and not mandated for onward referral.
Published: 21-Nov-2014, by Leeds
Valid until: 30-Nov-2017
This is a list of all the references that have passed critical appraisal for use in the care map Urology - Lower urinary tract infection (UTI) in females
- Clinical Knowledge Summaries (CKS). Urinary tract infection (lower) - women. (updated February 2013).
Newcastle upon Tyne: CKS; 2009.
- Map of Medicine (MoM) Clinical Editorial team and Fellows, and independent reviewers invited by Map of
Medicine. London: MoM; 2011.
- Scottish Intercollegiate Guidelines Network (SIGN). Management of suspected bacterial urinary tract infection in adults. A national clinical guideline. SIGN Publication no. 88. Edinburgh: SIGN; 2012. http://www.sign.ac.uk/pdf/sign88.pdf
- Anderson J, Fawcett D, Feehally J et al. Joint consensus statement on the initial assessment of haematuria.
London: Renal Association (RA) and British Association of Urological Surgeons (BAUS); 2008. http://www.renal.org/Libraries/Other_Guidlines/Haematuria_-_RA-BAUS_consensus_guideline_2008. sflb.ashx
- European Association of Urology (EAU). Urological Infections. The Netherlands: EAU; 2013. http://www.uroweb.org/gls/pdf/18_Urological%20infections_LR.pdf
- Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database
Syst Rev 2012; 10: CD001321. http://www.ncbi.nlm.nih.gov/pubmed/23076891
- Practice-informed recommendations, including contributors representing the Royal College of General
- Health Protection Agency (HPA). Management of infection. Guidance for primary care for consultation and local adaptation. London: HPA; 2010. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1279888711402
- Health Protection Agency (HPA). Diagnosis of UTI. Quick reference guide for primary care. London: HPA;
- British National Formulary (BNF). BNF 65. London: BMJ Group and RPS Publishing; 2013. http://www.bnf.org/bnf/index.htm
- National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer.
Clinical guideline 27 (updated 2011). London: NICE; 2005. http://www.nice.org.uk/cg27